man explaining something to a group of people

Too often we think of health as the presence or absence of a specific disease and its effects on a specific body. But what gets lost when we focus only on microbes and clinically-observable conditions? How can we widen our lens and think about health as an intersection of relationships that are simultaneously social and environmental; historically specific and culturally relative?

On this page, participants of CHE's 2011 Place-Based workshop, Landscapes of Health, have gathered their reflections from their experience of traveling around the state of Wisconsin and exploring a sample of the diverse places and landscapes that shape health. What unites these reflections is an attempt to suggest ways that we can adjust our gaze, rethink our assumptions, and explore health as both an idea and reality that goes "beyond the clinic."

Reflections from a River

See beyond written ink
Beyond paper
Beyond what we think
Hear a call from the wilderness
Mother Nature at her best
Feel Mother Nature rest
The crane birds, the trees, the plants, the air
Rejuvenate revitalize and be aware
All tangible beings at Badger Ammunition are still there
Walnut Way Conservation Corps
Kinnickkinnick/ Menomonee River and More
Brownfield improvement set to restore
Dig deep down past four feet of river depth
At rivers breadth
Where boarded houses are kept
"Go Home" they shouted and said
Invisible lines still a test
Uniting communities at best
The health and environment outside clinical walls
La Clinica/16th Street Clinic's worldwide community call
To design and improve an urban fall
The James E. Groppl Unity Bridge's open gates
Businesses hope to help generate
The goal of common state
Red line, invisible line, black ink line,
"where food grows on the water" a Sokaogon/Bad River Nations sign
Shedding tears, equally divine
Caring neighbors make good communities
when sharing digital and short stories
while dreaming of wht could be
Clean water, green fields amidst cold, grey concrete
Linwood Treatment Plant ozone complete
In a city where 3 rivers meet
Traveling the beautiful Wisconsin State within 4 days
Learning from colleagues, speakers and professors in so many ways
That Health and the Environment, is together, harmoniously

By Diana Peterson (blueskywoman)

Beyond the Clinic - Themes

Consider the Unseen

Health is More than the Physical

photo of old and rusted water tower

The most important landscape of health may be one you can't directly see. While health exists and interacts at many different scales– from watershed-wide groundwater health to the infection of individual cells – the mental health landscape lacks any dimensions at all, and yet it affects the well-being of the body and the community. So when first looking at any size landscape, to understand it you must start by using your ears, not your eyes. Stop and listen to the people living there – how do they relate to the place? How are they disconnected and out of sync? Are they impassioned? Depressed? Hopeful? Determined? Resigned? Only by listening to how people feel will you have clues to their mental landscape. Only by overlaying this unseen mental world on top of the physical and cultural topography will you be able understand and address the total health of the landscape.

Upstream, Downstream, We All Scream for What's in the Stream?

photo of concrete ditch in urban area

Water and topography play crucial, if often unnoticed, roles in shaping human and non-human health. As it takes the path of least resistance through stream beds, across city streets, or down stormwater drains, water can connect all kinds of organisms with industrial or waste-disposal sites that—if not for the geographies of watersheds—would otherwise seem far removed. Vegetable gardens, drinking wells, or your favorite fishing spot might actually be quite cozy neighbors with that paper mill or agribusiness facility "all the way" across town. But it isn't always easy to predict which way that nasty stuff is flowing. Anadromous fish, flesh contaminated via poisoned food-webs, might swim toxics upriver into the bellies of unsuspecting anglers. Groundwater flow, though it often mimics surface topography, gets complicated by dams, wells, and urban runoff. Where is your water coming from and where might it be going?

Finding Health in Junk Food

photo of package of wild rice

A bag of malted milk balls eaten during a workshop about health may, at first, seem counterintuitive. They have so much sugar and fat! How can milk balls be healthy? The answer is that health from food is not only in fats, sugars, carbohydrates, and vitamins. The health from food can include things like where the ingredients are grown, where the food is purchased, and where you consumed it. Different communities understand the relationship between health and food in different ways. For the Sokaogon, wild rice is an example of a sacred food because it gives health not just through consumption, but also by growing it, harvesting it, giving it and receiving it. Health, to the Sokaogon, is found in a shared tradition of cultivating the wild rice. They know that the rice was cultivated and eaten by their ancestors and that it will be cultivated and eaten by their descendants. My friend gave me a bag of malted milk balls knowing that I may be hungry and that the sweet sugars will make me happy. This kind gesture, along with the Sokaogon's understanding of the health in wild rice, has helped me discover that junk food can also contain health.

Beyond the Data

Take the Sacred Seriously

photo of a tree with a religious symbol attached

While numbers can tell stories about the health of landscapes, humans, and other animals, they also can fall short in important ways. For example, statistics do not capture expressions of the sacred. Christian icons in a storefront window, singing and drumming, stories about wild rice, gratitude and humility described as blessings all point toward a desire for transcendence, an aspiration to weave together the past, present, and future. It might be difficult to know how to respond to someone from a different faith tradition, especially if we come from a more secular background. Think about the ways in which religious experiences or expectations may nourish the health of peoples and places. How has belief motivated people in their everyday practices to cultivate health? Or in their long-term plans to manage landscapes like a forest? Were there important changes over time? How do individuals let belief show? In what ways were sacred encounters made manifest to outsiders? What kinds of translation issues developed if any? In thinking about expressions of the sacred, we might learn also how notions of health work through multiple belief systems.

Take the Sacred Seriously

photo of a poster of a bed with the text 'for too many babies last year, this was their final resting place

Numbers don't always touch a nerve. Perhaps a statistician might object, but both health disparities and clinical successes are best told with a story, not with a graph or a list. I was not numb to size of the problems on health our country is facing. But I only could grasp the big picture when individual people explained why they worked as a rural dentist or served on a neighborhood committee fighting mines. The power of narrative makes sense: of coursepeople respond to individual stories more than charts. But that is a lesson academics can hear over and over again. Our audience can see the big picture, as long as we help them access it with a good story. There is a place for Humanities folks at the Science table. Together we can construct the narratives that will help larger audiences feel the power of the work already being done on health.

Consider the Exchange

photo of a group of students walking on a sidewalk

It is interesting to consider how the groups we visited felt about us in the minutes and hours and days after our departure. Did we leave anything behind—any vestiges of our having been there? In short, did we do anything in making our rounds of Wisconsin and coming face to face with those who, every day, face the troubled intersection of health, landscape, and politics? Was the landscape of health made healthier, more ill, or left untouched by our passing through it? We were warned that the tricky politics of our trip—inevitably characterized, though with truly honorable intentions, by "drive-by scholarship" - might attain a sickening edge were we to find too-brief inspiration and sympathy and then fail to follow up on promises. For most of us, then, our presence in the lives of those we visited remains nearly ephemeral—the work of a morning or afternoon. And in truth, it is unlikely that, given our chaotic academic lives, there will be a sea change amongst our members that leads us all back to these specific people and places, at the expense of or even alongside our current responsibilities.

photo of a group looking at a community garden

But it does seem possible that this trip was an experience of health, despite its difficult subject matter—that our presence, however brief, initiated a widening of community, a rhizomatic expansion of the landscape of health that may inspire new and unconsidered opportunities for political, conceptual, or imaginative coalitions. We may, in short, act, think, write, and create differently than before. Indeed, even if all that this trip did was to connect us to real people doing profoundly important things, it also infused our abstract personal landscapes of books and archives and metaphoric language with remnants of that reality. And we can hope that it has done the same for those on the other side of the exchange.

Remember the People

artistic drawing of outlines of people

Often, to understand environmental health, we look at statistics, graphs, and reports. While these tools are essential to understanding problems and strategizing solutions, they do not offer a complete picture. One element that is missing from these studies are the real people behind the numbers. In Mole Lake, we met Tina who had spent many years in meetings and in courtrooms fighting to save the water and the land to which she, her ancestors, and her children belong. Their relationships and connections to the land cannot be separated from who they are. She told stories about her father going out in his boat to gather wild rice, about her brothers dancing the rice once it was dried, and about the power of cooking and eating the rice when she know all the labor that went into harvesting it. She spoke slowly, straight from the heart. Numbers do not convey the emotional and spiritual aspects of environmental health. Looking into the eyes of Tina and the other Sacaogon Ojibwe elders made me realize that we must always remember the real human and nonhuman beings behind the data.

Connect Ecologies with Communities

Consider the Paths of Water

people standing up to their ankles in water

Water. For the Sokaogon people, it is the blood of mother Earth. It flows in arteries and veins, nourishing all living things and carrying the environmental burdens of human society. It follows the path of least resistance. As sulfur, dislodged from mineral ores, mixes with oxygen and water, rivulets of acid flow. Droplets of hydrophobic PCBs skitter down waterways, coming to rest in bottom sediments. What serendipitous mixtures have arisen that give ecological advantage to parasites like Cryptospiridium? In deep tunnels beneath city streets, and in concrete rivers where dogs and children play, water makes its way to Lake Michigan--blind to the good or bad it carries. It moves through human communities least able to resist the flow of human power and greed that has channeled toxic exposures inequitably into individual bodies and neighborhoods. Water has always been and remains the most basic element of life. It carries, too, the residues of past human deeds and nourishes our fears for future survival.

Consider the Paths of Water

a store window with the text 'helping and healing our community'

The maintenance of physical health and cultural health are interrelated, so the latter should not be neglected for the former. According to multicultural education scholar Gloria Ladson-Billings, "culturally relevant teaching uses student culture in order to maintain it and to transcend the negative effects of the dominant culture." The College of Menominee Nation (CMN) nursing program embraces a similar philosophy. They shift the focus from their students, in part, to the patients. The CMN nursing philosophy states that "transcultural nursing care requires the nurse to recognize and honor the culture and cultural influences of their patients/clients just as they need to incorporate their own culture into the therapeutic relationship and care delivery." The program is organized around the Menominee Nation Clan System, reinforcing the cultural values of the community in which many of the program's students will work. (The Menominee Clinic hires its nurses exclusively from CMN.) CMN prepares its nurses to provide care that honors patients' physical and cultural health. Providing health care that improves an individual's well-being without sacrificing the health of the community requires looking beyond the walls of the clinic.

Search for How a Community Comes Together

an empty field next to a house

What can a look in yards, as we walk or drive by, let us know about diets, and the relationships of residents to food, in the neighborhoods we visited? Taking a walk through the neighborhood can help suggest the types of food which are easily accessible. Walnut Way has made spreading gardens part of its vision, but on the South Side I saw many homes which had little lawn space available for gardens. What choices do people make about how to manage the spaces they have available in which to grow plants? (A deeper look would require research to determine the quality, and safety, of the soil.) What connections are city residents able to make to cultural traditions, via what they grow in their gardens? Gardens might often focus an individual's attention on their own land, but community projects like Walnut Way can help neighbors come to together, to an extent; coming together to share labor, and to share stories about past food and agricultural traditions. How many people in these neighborhoods have the ability to know their food (and the labor and energy required to produce it) based on personal experience within their neighborhoods?

Can We Ever Separate from Ecology?

man standing on a drainage pipe in the woods

This workshop put a sharp edge on the familiar revenge of ecology: interconnectedness certainly does send our poisons back at us. Mike Wiggins Jr., chairman of the Bad River Band of Lake Superior Chippewa Indians, said, "none of us—black red white brown—none of us think of going out and drinking water—going to a stream and thinking, I'm thirsty I'm going to drink some water. That's not a possibility for any of us anymore." Later we went to the water treatment plant in Milwaukee and saw a bit of Lake Michigan sinking, so slowly its movement was imperceptible, through the giant filters. In the Fox River Valley we learned about PCBs from the paper industry and efforts to educate people who fish the river for sustenance about the dangers of eating the fish in it. On the societal level, our health depends on having the wherewithal to power things like municipal water treatment systems; on the individual level, it depends on having the privilege to afford healthy food. We are healthy, it seems, only to the extent that we can separate our own food and drink from ecologies of illness we have set in motion.

Power of Local Leaders

painted mural reading 'caring neighbors make good communities

Throughout the whole trip, but at Walnut Way in particular, we witnessed the important role of local leaders in the healing process and in creating health. I was amazed at the power of Sharon and Larry Adams and the others at Walnut Way Conservation Corp to transform a Milwaukee neighborhood. From condemned houses and empty lots had sprung a beautiful garden and a neighborhood safer and healthier for residents. Those at Walnut Way helped to begin the process of healing a neighborhood that had suffered from terrible wounds both intentional, such as redlining, and structural, such as unemployment. This healing process is fragile and can be slowed or destroyed at anytime, which is why coalitions at the local, state, and national levels are vital for continuing strong and healing growth. These coalitions are important not just for the resources that can flow among communities but also for the knowledge and emotional connections that are necessary for sustaining life.

A Bigger Picture Needs a Bigger Lens

Regional and International Ties

photo of an American Indian drum

Even as we witnessed healing projects taking place in sites around Wisconsin, I wondered about the regional and international components to these stories. We are all connected and the knowledge and experience produced by the Sokaogon Chippewa community's fight to stop the Crandon Mines project can be useful elsewhere (just as transnational mining companies are drawing on the lessons of mining conflicts across the globe to better carry out their goals). But thinking about scale, from local to regional to global, also reminds us about the different connections we choose to build and the communities we chose to construct. As we define what "our" communities are, and what it means for these communities to be healthy, we should also be mindful of the borders we draw around our communities. These borders help define who or what is alien to our communities (whether plant, or animal, or human) as well as what counts as pollution (roughly "matter out of place" according to Mary Douglas). Though it is not always the case, making one community healthy can adversely affect other communities and even the healthiest communities have an interest in policing their borders.

Regional and International Ties

photo of an old building near water

Judy Leavitt's fascinating presentation on public health in 19th- and early 20th-century urban America--complete with images of overflowing alley privies, of children playing in streets littered with garbage and dead animals--made me deeply grateful for modern sanitation and for the good water produced from plants like the Milwaukee water works we visited. I could imagine, however inadequately, the horrors of the disease epidemics that took place a century ago, and I felt glad to live in an era of greater technological advancement. Yet those earlier bacterial diseases took their toll only on the population living in a particular place and time. In contrast– as other parts of our trip made evident--so many of the toxins that we Americans have been releasing into the air and water in recent decades travel far through aquifers or on the winds or leach into the soil. They do not necessarily remain localized. And they will continue to produce health problems, genetic mutations, and extinctions for the foreseeable future. The sorrow I feel when I think of what our technologically advanced society is doing to the world we leave to future generations is unspeakable.

Valley of the Floods

students standing on broken pavement near flooded area

Milwaukee's Kinnickinnic River, or the KK as it is called by the locals, is an engineered sewer, a day-lit ditch, a non-navigable concrete canal. To be blunt, it is an eyesore. Though fifty years ago, when the KK river bed was channelized to increase the conveyance flow of the water, the primary purpose was not aesthetics but to prevent basement floods of the nearby neighbors. It was a public health project known as flood control. "Control" may seem like strong language, but it is the operative word here and was part of the mid-century obsession with mobility, speed and newness. Today it just looks sclerotic. So over the next few years, the river will be undergoing physical therapy. The concrete will be removed as well as the many adjacent homes built in flood zones. The plan is not to restore the KK River, but to rehabilitate it -- to allow it to function in a way that embraces the complex entanglements of the culture, history and environment of the place. Respecting its CHE-ology, if you will.

Learn from Everyday Practices

photo of a plate with bagel and fruit with a coffee cup

This is a photo of a pretty pedestrian breakfast. It was a quick meal eaten without much thought just before climbing onto the bus for another full day of traveling and intellectual stimulation. It was quite different than the dinner eaten the night before. Priot to eating, our host from the Menominee tribe delivered a soulful and lengthy prayer in his native language, and after he and his fellow musicians elicited deep gratitude from us with the rhythmic thumping of their sacred drums. But was breakfast really that different? Could have it been eaten, albeit with less fanfare, with the same spiritual intention? I was reminded by our host the important role food plays in making a connection to the divine for so many people and cultures. And these connections with the divine are part of an everday relationship, and an everday practice, even if it's just through a bagel and cup of coffee. Ultimately, if we see health as a measure of the status of our relationships with our environment in the broadest sense, then this relationship with the divine, expressed often through prayer and mealtime, is also an essential part of health for so many people.

Knowledge is Power(ful)

Out of Sight, Out of Mind?

person photographing water under a bridge

Shortly after our return, I heard an NPR interview with the author of a book on bumper stickers; his favorite read something like "if ignorance is bliss, why aren't more people happy?" Our trip prompted a lot of thought and emotion around issues of ignorance and knowledge. Because many of the problems we were studying involve agents that are invisible or not readily visible (chemicals like PCBs, say, or the fire retardants posing a new threat to our water supply), it is easy for the general population to remain ignorant about their presence or their effects. It's also easy for those with a financial stake in producing those chemicals to take advantage of that invisibility in hiding what they know. Our visit to the Paper Museum was disturbing partly because the kind people who took their time to speak with us were, presumably without knowing it, presenting to the public information that was either wrong or incomplete, and which obscured the culpability of the paper companies. There we also observed inabilities to recognize interconnectedness fully-- ignorance of what Timothy Morton calls "the ecological thought." How can methods of PCB remediation better take into account the health of the full river ecosystem? How can warnings about fish consumption better respond to the cultural and economic needs of immigrant subsistence fishermen? Clearly, knowledge doesn't produce bliss any more than ignorance does. Indeed, in our poisoned world, knowledge can produce profound grief and alarm. It's my hope, however, that ranging interdisciplinary knowledge will provide the basis for wise action.

"Choose Wisely"

poster of a fish with the text 'choose wisely. A health guide for eating fish in Wisconsin

This simple instruction raises complex questions about choice and health. While fishing is a Wisconsin longstanding tradition, industry has left a legacy of polluted waterways. Along the Fox River, home to one of the world's highest concentrations of paper mills, PCBs present especial danger. Fish offer a nutritious and inexpensive way to feed one's family, but because PCBs bioaccumulate over time, eating fish regularly carries a possibility of harm to developing fetuses and human reproductive and immune systems. What does it mean to make a wise choice when confronted with uncertainty and difficult tradeoffs? Does the frame of "choice" itself belie deeper issues of culture and class? The Wisconsin DNR fish consumption advisory does admirable work communicating the complicated risks associated with different rivers and lakes, species of fish, and methods of preparation. It provides resources in English, Spanish, and Hmong. But is it enough to make information available? Traditional Hmong recipes use the whole fish—might cultural needs not outweigh the cooking recommendations of a DNR pamphlet? Should a family living in poverty opt for Fox River catfish or a fast food dinner?

The Forest for the Trees

Ponder the Possibilities

photo of a tree growing in community gardens

At Walnut Way, the beautiful peach tree orchard, with raised beds of lemon balm and greens nestled among the trees, stood in for a symbol of broad health—health of the body, of the land, of a collaborative community. We heard the story of how the neighbors wanted peach trees, but the organizers doubted the growing potential of peaches in a northern Wisconsin climate. But when the organizers checked with local horticulturists, they found that peaches could indeed grow easily and prolifically in the inner city Milwaukee neighborhood. The peach trees now produce pink blossoms in spring, ripe fruit in summer, standing as a testament to possibility--to horticultural and human growth alike.

The Art of Healing

art of hands healing with water and food

In 2006, the City of Milwaukee installed two commemorative murals at the intersection of Interstate 43 and Fond Du Lac Avenue. They depict the escapes of two fugitive slaves, Joshua Glover and Caroline Quarles, from Wisconsin in the decades before the Civil War. Those familiar with Milwaukee will know that the murals sit at one of the historical dividing lines between Milwaukee's segregated communities. When the murals were installed, it was hoped they would signal a new spirit of cooperation and uplift, literally bridging the past to the present in an attempt to overcome painful historical woes.

Public art projects like Milwaukee's Underground Railroad murals do not always make meaning in quite the way city leaders, artists, or local residents quite intended. Partly for this reason, it seems monuments and other sites of remembrance deserve a more prominent place in discussions of health outside of the clinic. A wide-open embrace of artistic possibility might unlock exciting new ways of seeing a landscape's therapeutic and healing potentials.

The Work of Health

Working Towards Health

photo of people laughing outside a house

Across the United States, but particularly in labor strongholds in the upper Midwest—most evidently Wisconsin, but also Indiana, my workplace of Ohio, and my home state of Michigan—it would be an understatement to say that labor has occupied a central place in people's minds the past few months. When I think about labor, the environment, and health, the first thing I think about is, indeed, the role of organized labor to bargain for our health care and to ensure our working environments are safe. Yet the 2011 CHE place-based workshop made me consider another kind of healthy working: labors of love.

From the practitioners at community health clinics to the technicians at Milwaukee's water treatment facility, and from the non-profit managers at Walnut Way to the Dean of the nursing program at the Menominee tribal college, what struck me most about learning from the workers in these environments was the joy they took in their jobs. Perhaps I am all too easily sold on quintessential American mythologies of success ("If you just work hard enough…."), but rather than dismiss this, I want to think critically about how startling this love for work was, and why. It does, indeed, seem like common discourse about working tends to paint it as something arduous. Alternatively, even when we value work and argue for fair compensation, we tend to see labor as always exploited. In a world where the discursive environment suggests that work is to be avoided, stories that center on loving work are stunning.

photo of people talking

If work becomes not a burden, but a joy, how do our conversations about it change? What kinds of labor would we learn to value? How would our paychecks be recalibrated? How would widespread pleasure in work lead to healthier living for workers and their communities? I often teach Anzia Yezierska's 1923 autobiographical essay "America and I" in my Introduction to Ethnic Studies class. In this essay, a new immigrant, who had been laboring in New York's garment district sweatshops, confronts a "young, college-looking woman" with "Smartness and health shining from her eyes" who is described as "a person that is happy by what she does" working at a vocational guidance center. The protagonist/narrator/author pleads to her, "I want to work by what's in me" (1654). Ultimately, Yezierska becomes a writer. In writing about her environment, the tenement living of the Lower East side, she finds joy in her work—and "found America." She ends her essay by writing, "My very joy in doing the work I love hurts me like a secret guilt, because all around me I see so many with my longings, my burning eagerness, to do and be, wasting their energies in drudgery they hate, merely to buy bread and pay rent." She promises that "The Americans of tomorrow, the America that is every day coming nearer to be, will be too wise, too open-hearted, too friendly-handed, to let the least lastcomer at their gates knock in vain with his gifts unwanted."

painted mural of cars, farms and homes

Clearly, as the devaluation of labor in contemporary popular discourse shows, Yezierska's America—an America that "work[s] by what's in [it]"—has not yet fully come into being. Yet perhaps, like the workers we encountered on the place-based workshops, we can find the joy within ourselves and spread it via our labor to our communities, making a healthier America in a process like the one Yezierska describes: "I saw America—a big idea—a deathless hope—a world still in the making" (1656).

Works Cited: Yezierska, Anzia. "America and I." The Heath Anthology of American Literature. Vol. 2. 5th Ed. Ed. Paul Lauter. New York: Houghton Mifflin, 2005. 1650-1656.